401k Plan data: GILFORD-JOHNSON FLOORING, LLC GROUP BENEFIT PLAN plan

GILFORD-JOHNSON FLOORING, LLC GROUP BENEFIT PLAN 401k Plan overview

Plan Name	GILFORD-JOHNSON FLOORING, LLC GROUP BENEFIT PLAN
Plan identification number	501

GILFORD-JOHNSON FLOORING, LLC GROUP BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Temporary disability (accident and sickness) Other welfare benefit cover

401k Sponsoring company profile

GILFORD JOHNSON FLOORING has sponsored the creation of one or more 401k plans.

Company Name: GILFORD JOHNSON FLOORING

Employer identification number (EIN): 475085344

NAIC Classification: 423990
NAIC Description: Other Miscellaneous Durable Goods Merchant Wholesalers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GILFORD-JOHNSON FLOORING, LLC GROUP BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2016-01-01

Plan Statistics for GILFORD-JOHNSON FLOORING, LLC GROUP BENEFIT PLAN

401k plan membership statisitcs for GILFORD-JOHNSON FLOORING, LLC GROUP BENEFIT PLAN

Measure Date Value
2016: GILFORD-JOHNSON FLOORING, LLC GROUP BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 101
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
Total participants 2016-01-01 0

Measure	Date	Value
2016: GILFORD-JOHNSON FLOORING, LLC GROUP BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	101
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
Total participants	2016-01-01	0

Form 5500 Responses for GILFORD-JOHNSON FLOORING, LLC GROUP BENEFIT PLAN

2016: GILFORD-JOHNSON FLOORING, LLC GROUP BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	First time form 5500 has been submitted	Yes
2016-01-01	This submission is the final filing	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010157073

Policy instance

Insurance contract or identification number	000010157073
Number of Individuals Covered	101
Insurance policy start date	2016-01-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $432
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $2,880
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $144
Insurance broker organization code?	3
Insurance broker name	EPIC INSURANCE SOLUTIONS, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010157074

Policy instance

Insurance contract or identification number	000010157074
Number of Individuals Covered	44
Insurance policy start date	2016-01-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $513
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $172
Insurance broker organization code?	3
Insurance broker name	EPIC INSURANCE SOLUTIONS, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

400001000 14905

Policy instance

Insurance contract or identification number	400001000 14905
Number of Individuals Covered	56
Insurance policy start date	2016-01-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $430
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $2,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $143
Insurance broker organization code?	3
Insurance broker name	EPIC INSURANCE SOLUTIONS, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000403001672

Policy instance

Insurance contract or identification number	000403001672
Number of Individuals Covered	3
Insurance policy start date	2016-01-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $29
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $194
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10
Insurance broker organization code?	3
Insurance broker name	EPIC INSURANCE SOLUTIONS, LLC

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Company Name:	GILFORD JOHNSON FLOORING
Employer identification number (EIN):	475085344
NAIC Classification:	423990
NAIC Description:	Other Miscellaneous Durable Goods Merchant Wholesalers